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A new scoring system using multiple immunohistochemical markers for diagnosis of uterine smooth muscle tumors.

The diagnosis of uterine smooth muscle neoplasms by light microscopy is difficult. Multiple classification schemes have been proposed based on mitotic rate, nuclear atypia, and the presence or absence of necrosis. None of these classification systems has been entirely successful. This study was undertaken to evaluate the use of selected immunohistochemical and histochemical markers in differentiating these tumors, in addition to accepted morphologic criteria. Ten cases of each of the following: leiomyosarcomas (LMS), atypical leiomyomas (AL), cellular leiomyomas (CL) and usual leiomyomas (UL), were classically evaluated for histological diagnosis and were stained for Ki-67 (MIB-1), bcl- 2 and p53 using monoclonal antibodies and the avidin-biotin peroxidase method, and argyrophilic nucleolar organizer region (AgNORs). The number of stained cells was counted in the most positively stained region in a 4 mm2 square cover glass mounted on each slide. The mean value was calculated for each group of tumors. The data for Ki-67 (MIB- 1), bcl-2, p53 and AgNOR staining respectively, were significantly higher in LMS by comparison to UL, CL or AL. Because many singular cases had superimposed data being difficult to diagnose, a new scoring system for pathological evaluation was created. The results obtained by this scoring system suggest that immunohistochemical markers Ki-67 (MIB-1), bcl-2, p53 together with the AgNOR staining could be useful, by the scoring system, as an adjunct to the current accepted morphologic criteria in differentiating smooth muscle tumors of the uterus.

Antigens, Nuclear↗

PubMedDate not supplied

Training faculty to evaluate the patient education skills of residents.

Nearly 44% of all outpatient visits result in a prescription for medicine; however, little emphasis is generally placed on training or evaluating residents' ability to teach patients about medication. Often faculty themselves have not received training in this subject, nor have they been trained to systematically evaluate patient education skills. As a result, this whole area of communications with patients is commonly overlooked. Even if skills are evaluated, different standards and criteria may be applied resulting in inconsistent feedback to residents' ability to communicate efficiently and effectively with patients about medication prescribed. Faculty participating in the program increased their ability to consistently evaluate resident performance with 80% accuracy. In addition, faculty reported increase in their own ability to communicate more effectively with patients about medication.

Faculty, Medical↗